The block chain – a facilitator in healthcare data management

Until now, the digitalisation of the healthcare domain – of medical records and of various administrative systems – has meant various problems regarding integration and difficulties when it comes to efficiency and ease of use. The block chain could be a solution.

A technical field called the block chain has the potential to be an important component for creating accessibility as well as security and simplicity. The technology is based on the sharing of information among multiple parties. The information which is shared, however, is not the original documents, such as registries and medical records, but verifications of these.

Today’s burst of healthcare data – confusion about the way ahead

“e-Hälsovision 2025” was jointly formulated by the government and the Swedish Association of Local Authorities and Regions in early 2016, and constitutes the target for when e-health is to be developed by. By taking advantage of the possibilities that the digitalisation offers, we can now enhance the quality and efficiency within the welfare sector. Multiple actors and initiatives are contributing to the digitalisation in a range of arenas and through various development projects.

Unfortunately, a guide for creating common principles for all these efforts is missing. Over the years, the Ministry of Health and Social Affairs has been formulating visions and targets that are seldom translated into operational activity. Real cooperation and common approaches have turned out to be difficult to achieve within Swedish healthcare.

The healthcare labyrinth, with municipal autonomy and a plethora of self-contained systems for healthcare data management, is becoming even more complex as the healthcare responsibilities of the municipalities are increasing in a Sweden where the population is aging. Everyone seems to be looking at each other, seemingly drowsy as if newly awakened, wondering how real digitalisation is to come about and where someone is to be found who dares to take the lead in the innovation work.

At the same time, many interesting initiatives are being taken on in different parts of the world by actors outside of the healthcare sector. Actors in telecom and IT are investing large sums in the attempts to tie the new and increasingly large flows of data into new infrastructure solutions. New platforms are created for handling the rapidly increasing amounts of data, which are generated when citizens and patients produce self-generated data. For the individual, it can be vital to learn more about what is achieved from exercising, what the results of the efforts are, or keeping track of the rehabilitation process.

To get the full benefits of healthcare digitalisation and the aforementioned co-creation, we need to bring about common principles for a number of things, such as standards and ownership of data. However, achieving these common principles for fundamental infrastructure components and management functions will take a long time, and the question is whether there are new technologies that can bring about order in the data management.

The future – The block chain provides new perspectives, and can be a possible road ahead

We have had a closer look at the block chain, a new technological field which constitutes the foundation of the Bitcoin currency. The Bitcoin system has solved several problems that the digital world previously did not have any solutions to. Three of these are:

  1. The possibility of creating digital originals that cannot be copied.
  2. The possibility of ensuring that digital files have not been altered or manipulated.
  3. The possibility of ensuring that predefined processes and flows of authorisations have been followed.

In the case of Bitcoin, we can note that the system has been working over seven years and that the currency is still holding value. This would not have been possible if people were able to copy the digital units and use them multiple times. The system must therefore have solved the problem of creating digital originals.

The above solutions have very broad applications which are now tested around the world. One example, which we are working with, is the transfer of property. With previous technical solutions, we cannot trust that digital signatures and contracts really are secure and impossible to manipulate. The process of property acquisition is therefore very lengthy and includes a lot of documents and processes such as contracts of sale, promissory notes, deeds of purchase, escrow agreements and property descriptions, etc. Documents must be signed, posted and stored, and the process is lengthy.

In a cooperation between the Lantmäteriet (the Swedish land survey), ChromaWay, Telia, Landshypotek Bank, SBAB and Kairos Future, we are now developing a technical solution and a process that is considerably more simple while also being more secure.

The World Bank has shown great interest in the project, which will be presented at a global conference organised by the World Bank in Washington D.C. The possibility of ensuring a property registry might gain  enormous significance in countries where the right to land is unclear. Land investments, in the form of plantations, properties, etc., are hampered if ownership might be lost.

In a similar way, actors all around the world today are looking at what the possibilities in the field of healthcare might be. The following are some examples of block chain applications that we are studying:

  • Pharmaceuticals may be tracked from production to the end user, making counterfeit copies more difficult to sell.
  • The authenticity of important documents such as prescriptions, medical records, etc. can be ensured and access can be controlled by the patients themselves, or by their caretakers following pre-defined terms.
  • Validation of education, language proficiency, certifications, licenses etc. of staff and organisations – something that becomes crucial when the labour force is getting increasingly mobile and when education as well as healthcare is becoming more international.

Interoperability – the ability of different systems to function together and communicate – remains a challenge that the healthcare sector will need to solve. The block chain technology provides opportunities to approach the issue of interoperability with an approach in which identity is the key. Instead of trying to harmonise data through the networks, we can establish a unique identifier of individuals. This will be the common thread in the global registry for the data about an individual that is stored in different locations.

Through an automated integrity solution, users can trust the data management. The trust is moved away from being in one single place, where an individual party is influencing it, to being spread across entire networks of computers. Everything is shared through the global network and new transactions end up in a new block that is added to the chain. Data is timestamped and signed, and a private key is used to prevent manipulation. The users would not only know if the data had been manipulated, but be able to see exactly how it was manipulated.

A number of international experts deem that the block chain technology is the missing link for creating the prerequisites for scalability, integrity solutions, and trust in the increasingly connected domain that is often called the “Internet of Things.” In a world of billions of connected gadgets related to healthcare and safety, block chain applications can contribute transactions and coordination between connected devices in a more resistant ecosystem.

We are convinced that a range of proposals of processes and technical solutions using the block chain will be demonstrated over the next few years. The technology has the potential to revolutionise the economy. We believe that Sweden, with its leading position in IT and comparably large capability of cooperation between private and public actors, organisations and research, can take the lead on this exciting development.

This article was originally published in Pharma Industry, no 1 2017.


By Mats Olsson and Magnus Kempe.